Effectiveness of a Decentralized Hub and Spoke Model for the Treatment of Hepatitis C Virus in a Federally Qualified Health Center.
Effectiveness of a Decentralized Hub and Spoke Model for the Treatment of Hepatitis C Virus in a Federally Qualified Health Center.
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DOI：
10.1002/hep4.1617
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发表时间：
2021-03
影响因子：
5.1
通讯作者：
Ramers CB
中科院分区：
文献类型：
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作者：
Rojas SA;Godino JG;Northrup A;Khasira M;Tam A;Asmus L;Frenette C;Ramers CB
丙型肝炎病毒（HCV）是美国肝硬化、肝癌和死亡率的主要原因。我们评估了由执业护士（NPs），初级保健医生（PMD）或传染病医生（ID MD）在加利福尼亚州圣地亚哥市的联邦合格卫生中心（CIMHC）使用直接作用的抗病毒药物进行分散式HCV治疗的有效性。我们对2014年1月至2020年1月期间在10家诊所接受6名NP，10名PMD和1名ID MD治疗的1，261名患者进行了横断面分析。保健服务是根据社区保健成果推广项目（ECHO项目）模式提供的，该模式有一个中心和九个辐条。如果患者在治疗12周后出现持续病毒学应答（SVR），则认为HCV已治愈（SVR 12）。我们使用泊松回归评估了供应商类型和中心或辐射状态之间的治愈率差异。患者为34%拉丁裔，16%黑人，63%年龄>50岁，59%无家可归; 53%患有晚期纤维化，69%为基因型1，5%合并感染人类免疫缺陷病毒。共有943例患者达到SVR 12（96%符合方案，73%意向治疗）。即使在调整人口统计学、资源和疾病特征后，ID MD和PMD（患病率比[PR]，1.00; 95%置信区间[CI]，0.95 - 1.04）或NP（PR，1.01; 95% CI，0.96 - 1.05）之间的治愈率也没有差异。同样，轮毂和轮辐之间也没有差异（PR，1.01; 95% CI，0.98 - 1.04）。结论：在低收入和大多数无家可归的患者队列中，由非专科医生提供的HCV治疗并不比专科医生提供的治疗差。
Hepatitis C virus (HCV) is a major cause of cirrhosis, liver cancer, and mortality in the United States. We assessed the effectiveness of decentralized HCV treatment delivered by nurse practitioners (NPs), primary care physicians (PMDs), or an infectious disease physician (ID MD) using direct‐acting antivirals in a Federally Qualified Health Center (FQHC) in urban San Diego, CA. We conducted a cross‐sectional analysis of 1,261 patients who received treatment from six NPs, 10 PMDs, and one ID MD practicing in 10 clinics between January 2014 and January 2020. Care was delivered based on the Extension for Community Healthcare Outcomes (Project ECHO) model with one hub and nine spokes. HCV was deemed cured if a patient had a sustained virologic response (SVR) after 12 weeks of treatment (SVR12). We evaluated differences in the prevalence of cure between provider types and hub or spoke status using Poisson regression. Patients were 34% Latino, 16% black, 63% were aged >50 years, and 59% were homeless; 53% had advanced fibrosis, 69% had genotype 1, and 5% were coinfected with human immunodeficiency virus. A total of 943 patients achieved SVR12 (96% per protocol and 73% intention to treat). Even after adjustment for demographics, resources, and disease characteristics, the prevalence of cure did not differ between the ID MD and PMDs (prevalence ratio [PR], 1.00; 95% confidence interval [CI], 0.95‐1.04) or NPs (PR, 1.01; 95% CI, 0.96‐1.05). Similarly, there were no differences between the hub and spokes (PR, 1.01; 95% CI, 0.98‐1.04). Conclusion: Among a low‐income and majority homeless cohort of patients at urban FQHC clinics, HCV treatment administered by nonspecialist providers was not inferior to that provided by a specialist.